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. 2024 Jun 12:11:1355409.
doi: 10.3389/frobt.2024.1355409. eCollection 2024.

A navigated, robot-driven laser craniotomy tool for frameless depth electrode implantation. An in-vivo recovery animal study

Fabian Winter  1 , Patrick Pilz  2 , Anne M Kramer  2 , Daniel Beer  3 , Patrick Gono  3 , Marta Morawska  3 , Johannes Hainfellner  4 , Sigrid Klotz  4 , Matthias Tomschik  1 , Ekaterina Pataraia  5 , Gilbert Hangel  6 , Christian Dorfer  1 , Karl Roessler  1
Affiliations

A navigated, robot-driven laser craniotomy tool for frameless depth electrode implantation. An in-vivo recovery animal study

Fabian Winter et al. Front Robot AI. .

Abstract

Objectives: We recently introduced a frameless, navigated, robot-driven laser tool for depth electrode implantation as an alternative to frame-based procedures. This method has only been used in cadaver and non-recovery studies. This is the first study to test the robot-driven laser tool in an in vivo recovery animal study. Methods: A preoperative computed tomography (CT) scan was conducted to plan trajectories in sheep specimens. Burr hole craniotomies were performed using a frameless, navigated, robot-driven laser tool. Depth electrodes were implanted after cut-through detection was confirmed. The electrodes were cut at the skin level postoperatively. Postoperative imaging was performed to verify accuracy. Histopathological analysis was performed on the bone, dura, and cortex samples. Results: Fourteen depth electrodes were implanted in two sheep specimens. Anesthetic protocols did not show any intraoperative irregularities. One sheep was euthanized on the same day of the procedure while the other sheep remained alive for 1 week without neurological deficits. Postoperative MRI and CT showed no intracerebral bleeding, infarction, or unintended damage. The average bone thickness was 6.2 mm (range 4.1-8.0 mm). The angulation of the planned trajectories varied from 65.5° to 87.4°. The deviation of the entry point performed by the frameless laser beam ranged from 0.27 mm to 2.24 mm. The histopathological analysis did not reveal any damage associated with the laser beam. Conclusion: The novel robot-driven laser craniotomy tool showed promising results in this first in vivo recovery study. These findings indicate that laser craniotomies can be performed safely and that cut-through detection is reliable.

Keywords: craniotomy; depth electrodes; epilepsy surgery; laser; navigated; robotic.

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Conflict of interest statement

DB, PG, and MM were employed by AOT, which is the company that provided the laser. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

FIGURE 1
FIGURE 1
Implantation of patient marker for navigation reference after surgical prepping.
FIGURE 2
FIGURE 2
Postoperative computed tomography imaging with 3-dimensional reconstruction showing the planned trajectory and depth electrode alignment.
FIGURE 3
FIGURE 3
Postoperative computed tomography imaging showing entry point deviations of < 1 mm.
FIGURE 4
FIGURE 4
Multiple depth electrodes with different angulations implanted through anchor bolts after laser ablation.
FIGURE 5
FIGURE 5
Cutting depth electrodes and anchor bolts allowing skin closure to prevent postoperative manipulation and reduce infarction risk.
FIGURE 6
FIGURE 6
Sheep 2: (A–D), Sheep 1: (E,F); (A) The stitch channel of the bone is sharply delineated and shows no connective scar tissue formation. The bone tissue surfacing the stitch channel shows a thin area with thermocoagulation artifacts (dark colored area). (B,D) The dura tissue surfacing the stitch channel shows a limited field with thermocoagulation artifact (dark colored area). (C) CNS tissue with tissue defect, whit limited surrounding tissue damage. (F) CNS tissue surrounding the stich channel shows fresh hemorrhages and edema. (E) within the stitch channel, tiny fragments of bone and fresh hemorrhage are visible. Scale Bars: 100 μm: (A), 150 μm: (D), 200 μm: (B), 500 μm: (C–F).
FIGURE 7
FIGURE 7
Operating room set-up during laser ablation. Robotic-assisted frameless laser osteotome in action.
See this image and copyright information in PMC

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